Article review—”The impending globalization of ADHD: Notes on the expansion and growth of a medicalized disorder”

The impending globalization of ADHD: Notes on the expansion and growth of a medicalized disorder. That is the title of a fairly recent article I happened to chance upon online. It sounds bad, doesn’t it? Words like impending, globalization and medicalized have an alarming ring to them. And when I tell you that I myself have not long ago been diagnosed with Adult ADHD, then you will no doubt understand why this article grabbed my attention. Read on to see what I thought of it.

The first thing to raise my eyebrows is the use of the verb ‘medicalized’ in connection with ADHD, so I found myself looking it up. The term ‘medicalization‘ was introduced by sociologists to describe the phenomenon, whereby conditions that are not self-evidently biological in origin become viewed as medical problems as a result of a shift in the attitude of society. Thus, scientists who consider ADHD to be a ‘medicalized’ condition are essentially proponents of the view that there is nothing medically wrong with people who receive the diagnosis of ADHD. Contrariwise, they would rather argue that there is something wrong with society. And to illustrate that point, such sociologists are often wont to cite the now abandoned practice of treating homosexuality as a medical condition, as a classic example of how a behavior may become medicalized by a society. So after reading all that, I naturally begin asking myself whether or not ADHD is a real medical problem. Am I the victim of society, of disease mongering?

I was intrigued by all this, so I started searching for related publications by the authors of this review. And so I discovered that the first author (Peter Conrad) happens to be one of the sociologists who first coined the term ‘medicalized’ in relation to ADHD (then known as ‘hyperkinesis’) almost 40 years ago. He has even written several books on this subject. It would therefore seem that the first author of this article is one of the founding fathers of ‘medicalization’ in a sociological context. Clearly, he approaches this publication with a long established critical attitude towards the diagnosis and treatment of ADHD. The press release from his university also makes it quite plain that the authors have a pronounced negative view of the current medical treatment of ADHD. And if ADHD is indeed a medicalized disorder, then perhaps quite rightly so.

But is ADHD really a medicalized disorder? The article states this so much as a fact, that it does not back this claim with references. Yet from a brief investigation it would appear that the assertion that ADHD is a medicalized disorder is not widely accepted outside the field of sociology. As such, shouldn’t that claim have been supported by references to scientific literature? Especially since medicalization is a critical part of the author’s explanation for the phenomenon of recent global increases in the diagnosis of ADHD, and even does so to the exclusion of other explanations for that trend. Like for example that ADHD is simply becoming better recognized and better understood. To be fair, the authors do mention another study (Faraone et al., 2003), but then seem to cherry pick a conclusion from that study in favor of the medicalization point of view.

There are other problems with the article. For example, the authors seem critical of the fact that adults are now also receiving ADHD diagnosis. This surprised me, as I would think the notion that ADHD is just a phase children pass through is a bit preposterous. Sure, they may develop coping mechanisms. But that is hardly the same as a complete recovery. And in fact recent studies have begun to demonstrate that brain imaging techniques may successfully differentiate between ADHD and normal brains well into adulthood. This sounds more plausible to me. I mean, what would you expect otherwise? A miraculous sudden recovery on the exact day a patient turns 18? And, as a matter of fact, wouldn’t there be more to the claim that ADHD is a medicalized disorder if the condition did not persist into adulthood? The authors explain the emergence of adult ADHD as evidence of a successful attempt by pharmaceutical companies to include grownups in the ADHD criteria, in order to expand their market. While that certainly may be a contributing factor, I do feel the article falls short by omitting other plausible explanations.

The article also contains a brief discussion of online self-test forms. The authors suggest that such self-test forms lead to an increase of ADHD diagnosis. While the authors have a good point, I think it is a rather ridiculous one to make. I mean, isn’t that the whole point of any self-test form to encourage people to find help if they need it? And if so, wouldn’t it be the mark of an exceptionally poor test if it did not lead to an increase in diagnoses? In similar vein, the authors implicate the Internet for its role in driving the emerging ADHD ‘pandemic’. This also seems a bit of a stretch if you ask me. I don’t know about how things are done in the US, but I cannot imagine that any real doctor in Europe would diagnose ADHD by having a child of five fill out a three-minute checklist on some company website of a large pharmaceutical multinational and then send him on his merry way with a large supply of stimulants. Of course you always have a few bad apples in the medical profession, but they are exceptions (thankfully).

Based on what I have read in the article, I am not convinced that ADHD is some kind of global medicalization epidemic. I think you can find evidence both for and against medicalization as the driving force behind internationally increasing ADHD diagnoses, so at best I would say that the question of whether we are on the cusp of a medicalized ADHD pandemic cannot be so definitively answered with the information currently available. Personally, I would think that the trend of increasing diagnoses is influenced by both an increase in understanding of the disorder, as well as medicalization. So then it would seem to me that the real challenge for a serious investigator of this phenomenon would be to find a way to tease apart these two layers underlying the epidemiological development of ADHD across the globe.

But until then, I would like to end this review with a brief quote taken from the introduction of the article: “…there is a gap in the sociological literature on how a medicalized diagnosis is able to migrate from the U.S. to other countries.” Indeed, and it would seem that this very much needed gap has now been filled. :P